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November 18, 1974

Management of Asthma in Childhood

JAMA. 1974;230(7):962-963. doi:10.1001/jama.1974.03240070014010

To the Editor.—  The EDITORIAL by Halpern (229:819, 1974) revives the assumption that the excessive use of isoproterenal aerosol has been the cause of increased asthma deaths in children and young people in Britain during the years 1961 through 1967, when the asthma mortality increase ran parallel to the sale of aerosol bottles. This parallelism, however, was not found in many other countries, such as the United States1 and Australia,2 and, therefore, most probably has been accidental or multifactorial. It has since become clear that if the abuse of β-adrenergic aerosols has led to death, this has been due to tolerance that developed when the drug was used every 30 to 60 minutes. This tolerance has been proved experimentally.3 Every practitioner can convince himself (as I have done since 1946) that in patients not responding to an aerosol of a 1% isoproterenal solution, a strong response is